Fraud and Abuse Limit Freedom of Choice
Fraud and abuse enforcers have stated periodically that one of the reasons they are so intent on prevention of violations is that they interfere with patients’ right to freedom of choice of providers. On May 18, 2017, in a speech at the American Bar Association 27th Annual Institute on Health Care Fraud, Acting Assistant Attorney General Kenneth A. Blanco of the Criminal Division of the United States Department of Justice (DOJ) explained why this is the case.
First, Mr. Blanco stated:
…let me be clear; health care fraud is a priority for the Department of Justice…The investigation and prosecution of health care fraud will continue; the department will be vigorous in its pursuit of those who violate the law in this area.
Mr. Blanco went on to say:
For so many reasons, health care fraud is particularly egregious, and frankly, in my view despicable. Greed resulting in the deprivation of medical care for those in need is cruelty. Many people focus on the money stolen, which is important. I focus on the impact it has on those in need, and on our great nation.
Then Mr. Blanco said:
People usually seek medical care when they are most vulnerable, when they are in need, sometimes helpless. Sometimes it is not just for them personally. Even more heart-wrenching, it is for their children or an elderly parent—people who they feel they need to protect either through obligation, morality or just plain love. Health care fraud deprives many of access to medical care, even the most basic forms of care, because fraud increases the costs for all of us…Under their own standards, health care professionals have a fiduciary duty to their patients – a duty that is shattered when those professionals exploit patients’ vulnerabilities for financial gain…
Mr. Blanco then gives a specific example of how fraudulent conduct violates patients’ right to freedom of choice of providers. In October, 2016, a national chain of hospitals entered into a settlement agreement with the government. The government alleged that hospitals in Georgia and South Carolina paid over $12 million in bribes to a chain of prenatal care clinics in exchange for referrals of Medicaid patients. The owners and operators of the clinics, according to the DOJ, made false statements and representations to these vulnerable expectant mothers, including that Medicaid would only cover the costs associated with their delivery and the care of their newborn baby, if the expectant mothers delivered at one of the hospitals. In addition, some expectant mothers were told that they were required to deliver their babies at one of the hospitals.
These statements left expectant mothers with the false and mistaken belief that they could not select hospitals of their choice. As a result, many expectant mothers traveled long distances from their homes to deliver at the hospitals, placing their health and safety and that of their babies at risk. Enough to make the blood boil!
In other words, fraud enforcement isn’t just about the money. It’s also about violations of important patients’ rights that, as Mr. Blanco points out, go to the heart of our “great nation.” Stop it!
Elizabeth E. Hogue, Esq.